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General NPI Number Information
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NPI Number | 1003032053
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Entity Type | Organization
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Legal Business Name | SUMMIT PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 06/20/2022
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Provider Practice Location Address
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Address Line | 621 N CHESTER ST
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City | NEW CUMBERLAND
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State | WV
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Zip | 26047-9604
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Country | US
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Telephone | 304-564-1098
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Fax | 304-564-5020
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Provider Business Mailing Address
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Address Line | 414 PENCO RD
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City | WEIRTON
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State | WV
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Zip | 26062-3822
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Country | US
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Telephone | 304-723-3780
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Fax | 304-723-4110
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Authorized Official
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Title or Position | OWNER
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Name | NICHOLAS MARTIN
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Credential |
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Telephone | 304-564-1098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 001084
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License Number State | WV
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